'Saying it without words': a qualitative study of oncology staff's experiences with speaking up about safety concerns.

OBJECTIVES To explore the experiences of oncology staff with communicating safety concerns and to examine situational factors and motivations surrounding the decision whether and how to speak up using semistructured interviews. SETTING 7 oncology departments of six hospitals in Switzerland. PARTICIPANTS Diverse sample of 32 experienced oncology healthcare professionals. RESULTS Nurses and doctors commonly experience situations which raise their concerns and require questioning, clarifying and correcting. Participants often used non-verbal communication to signal safety concerns. Speaking-up behaviour was strongly related to a clinical safety issue. Most episodes of 'silence' were connected to hygiene, isolation and invasive procedures. In contrast, there seemed to exist a strong culture to communicate questions, doubts and concerns relating to medication. Nearly all interviewees were concerned with 'how' to say it and in particular those of lower hierarchical status reflected on deliberate 'voicing tactics'. CONCLUSIONS Our results indicate a widely accepted culture to discuss any concerns relating to medication safety while other issues are more difficult to voice. Clinicians devote considerable efforts to evaluate the situation and sensitively decide whether and how to speak up. Our results can serve as a starting point to develop a shared understanding of risks and appropriate communication of safety concerns among staff in oncology.

Trade-offs between voice and silence: a qualitative exploration of oncology staff's decisions to speak up about safety concerns

BACKGROUND Research suggests that "silence", i.e., not voicing safety concerns, is common among health care professionals (HCPs). Speaking up about patient safety is vital to avoid errors reaching the patient and thus to prevent harm and also to improve a culture of teamwork and safety. The aim of our study was to explore factors that affect oncology staff's decision to voice safety concerns or to remain silent and to describe the trade-offs they make. METHODS In a qualitative interview study with 32 doctors and nurses from 7 oncology units we investigated motivations and barriers to speaking up towards co-workers and supervisors. An inductive thematic content analysis framework was applied to the transcripts. Based on the individual experiences of participants, we conceptualize the choice to voice concerns and the trade-offs involved. RESULTS Preventing patients from serious harm constitutes a strong motivation to speaking up but competes with anticipated negative outcomes. Decisions whether and how to voice concerns involved complex considerations and trade-offs. Many respondents reflected on whether the level of risk for a patient "justifies" the costs of speaking up. Various barriers for voicing concerns were reported, e.g., damaging relationships. Contextual factors, such as the presence of patients and co-workers in the alarming situation, affect the likelihood of anticipated negative outcomes. Speaking up to well-known co-workers was described as considerably easier whereas "not knowing the actor well" increases risks and potential costs of speaking up. CONCLUSIONS While doctors and nurses felt strong obligation to prevent errors reaching individual patients, they were not engaged in voicing concerns beyond this immediacy. Our results offer in-depth insight into fears and conditions conducive of silence and voicing and can be used for educational interventions and leader reinforcement.

The impact of structural conditions in communes on sports behaviour of adolescents and young adults in Switzerland

Young peoples’ sport activity in Switzerland differs considerably depending on the linguistic region (Lamprecht, Fischer, & Stamm, 2008). This appears to be based on cultural as well as on structural differences. The question then arises how differing structural conditions in communes (e.g. sport facilities, significance of the municipal promotion of sport) across different linguistic regions of Switzerland cause variation in sport behaviour. Based on the theory of social action (Coleman, 1990), it is assumed that individual behaviour is not only determined by individual but also by structural and socio-cultural factors in which a person is socially embedded. In two case studies, multilevel data was gathered analysing possible influences of structural factors on sports behaviour. Using an online survey, 15 to 25 year old inhabitants (N = 205) living in a German and French speaking commune were questioned about their sports participation in and outside of their commune, as well as their perception of sport-related structural characteristics in their commune. To collect information about communes’ sport facilities, the sport providers (N = 23) were interviewed. Sport-related characteristics of the communes were also collected through two interviews with representatives of the municipal administration. As expected, sport participation is significantly lower in the French speaking commune (Chi2 (1, N = 205) = 3.84, p < .05). Adolescents and young adults living in the French speaking commune are less satisfied with the sport infrastructure (F(1,135) = 9.65, p < .01) and evaluate the opportunities to be physically active in their commune significantly worse (F(1,144) = 15.33, p < .01) than their German-speaking counterparts. These first findings show the impact of structural conditions in communes on sport participation of adolescents and young people. However, it must be noted that this study is explorative and further communes would need to be examined in order to generalize the results. References Coleman, J. S. (1990). Foundations of social theory. Cambridge, MA: Belknap. Lamprecht, M., Fischer, A. & Stamm, H. (2008). Sport Schweiz 2008. Das Sportverhalten der Schweizer Bevölkerung. Magglingen: BASPO.

The impact of structural conditions in communes on physical activity and sports behaviour of adolescents and young adults in Switzerland

Introduction The physical activity of the Swiss population differs considerably depending on the linguistic region. German speakers are more often physically active than people living in the French- or Italian-speaking part of Switzerland (Stamm & Lamprecht, 2008). This study analyses how differing structural conditions in communes (e.g. sport facilities, significance of the municipal promotion of sport) across different linguistic regions of Switzerland correlate with physical activity and sports participation for adolescents and young adults. Methodological approach Based on the theory of social action (Coleman, 1990), it is assumed that individual behaviour is not only determined by individual but also by structural and socio-cultural factors in which a person is socially embedded. In two case studies, multilevel data was gathered analysing possible influences of structural factors on sports behaviour. Using an online survey, 15 to 25 year old inhabitants (N = 205) living in a German- and French-speaking commune were questioned about their sports participation in and outside of their commune, as well as their perception of sport-related structural characteristics in their commune. To collect information about communes’ sport facilities, the sport providers (N = 23) were interviewed. Sport-related characteristics of the communes were also collected through two interviews with representatives of the municipal administration. Results and discussion Physical activity is significantly higher (Chi2 (1, N = 183) = 4.78, p < .05) and sport participation is significantly lower in the French speaking commune (Chi2 (1, N = 205) = 3.84, p < .05). Adolescents and young adults in the French speaking commune (M = 3.15, SD = 1.23) are less satisfied with the opportunities to be physically active in the environment than their counterparts living in the German speaking commune (p < .001, Mann-Whitney U – test). These first findings show the impact of structural conditions in communes on physical activity and sport participation of adolescents and young people. However, it must be noted that this study is explorative and further communes would need to be examined in order to generalize the results. References Coleman J S (1990). Foundations of social theory. Belknap, Cambridge, MA. Stamm H, Lamprecht M (2008). EJSS, 8(1+2), 15-29.

Silence That Can Be Dangerous: A Vignette Study to Assess Healthcare Professionals' Likelihood of Speaking up about Safety Concerns

PURPOSE To investigate the likelihood of speaking up about patient safety in oncology and to clarify the effect of clinical and situational context factors on the likelihood of voicing concerns. PATIENTS AND METHODS 1013 nurses and doctors in oncology rated four clinical vignettes describing coworkers' errors and rule violations in a self-administered factorial survey (65% response rate). Multiple regression analysis was used to model the likelihood of speaking up as outcome of vignette attributes, responder's evaluations of the situation and personal characteristics. RESULTS Respondents reported a high likelihood of speaking up about patient safety but the variation between and within types of errors and rule violations was substantial. Staff without managerial function provided significantly higher levels of decision difficulty and discomfort to speak up. Based on the information presented in the vignettes, 74%-96% would speak up towards a supervisor failing to check a prescription, 45%-81% would point a coworker to a missed hand disinfection, 82%-94% would speak up towards nurses who violate a safety rule in medication preparation, and 59%-92% would question a doctor violating a safety rule in lumbar puncture. Several vignette attributes predicted the likelihood of speaking up. Perceived potential harm, anticipated discomfort, and decision difficulty were significant predictors of the likelihood of speaking up. CONCLUSIONS Clinicians' willingness to speak up about patient safety is considerably affected by contextual factors. Physicians and nurses without managerial function report substantial discomfort with speaking up. Oncology departments should provide staff with clear guidance and trainings on when and how to voice safety concerns.

Frequency of and predictors for withholding patient safety concerns among oncology staff: a survey study.

Speaking up about patient safety is vital to avoid errors reaching the patient and to improve a culture of safety. This study investigated the prevalence of non-speaking up despite concerns for safety and aimed to identify predictors for withholding voice among healthcare professionals (HCPs) in oncology. A self-administered questionnaire assessed safety concerns, speaking up beliefs and behaviours among nurses and doctors from nine oncology departments. Multiple regression analysis was used to identify predictors for withholding safety concerns. A total of 1013 HCPs returned the completed survey (response rate 65%). Safety concerns were common among responders. Fifty-four per cent reported to recognise their colleagues making potentially harmful errors at least sometimes. A majority of responders reported at least some episodes of withholding concerns about patient safety. Thirty-seven per cent said they remained silent at least once when they had information that might have helped prevent an incident. Respondents believed that a high level of interpersonal, communication and coping skills are necessary to speak up about patient safety issues at their workplace. Higher levels of perceived advocacy for patient safety and psychological safety significantly decreased the frequency of withholding voice. Remaining silent about safety concerns is a common phenomenon in oncology. Improved strategies are needed to support staff in effective communication and make cancer care safer.

Liberal and Radical Democracies: The Swiss Cantons Compared

This article examines the widespread hypothesis that German-speaking Swiss cantons exhibit radical-democratic characteristics, while the Latin cantons possess stronger liberal-representative democratic profiles. Empirical and multi-dimensional measuring of the quality of democracy in the cantons shows that this hypothesis does not do the complexity of cantonal democracy justice. Today’s position of the cantons along the axes of liberal and radical democracy is best explained with reference to the strong liberal and democratic constitutional movements within the cantons during the middle of the 19th century.

Factors influencing fixed retention practices in German-speaking Switzerland : A survey.

AIM Several surveys evaluate different retention approaches among orthodontists, but none exist for general dentists. The primary aim of this survey was to record the preferred fixed retainer designs and retention protocols amongst general dentists and orthodontists in Switzerland. A secondary aim was to investigate whether retention patterns were associated with parameters such as gender, university of graduation, time in practice, and specialist status. METHODS An anonymized questionnaire was distributed to general dentists (n = 401) and orthodontists (n = 398) practicing in the German-speaking part of Switzerland. A total of 768 questionnaires could be delivered, 562 (73.2 %) were returned and evaluated. Descriptive statistics were performed and responses to questions of interest were converted to binary outcomes and analyzed using multiple logistic regression. Any associations between the answers and gender, university of graduation (Swiss or foreign), years in practice, and specialist status (orthodontist/general dentist) were assessed. RESULTS Almost all responding orthodontists (98.0 %) and nearly a third of general dentists (29.6 %) reported bonding fixed retainers regularly. The answers were not associated with the practitioner's gender. The university of graduation and number of years in practice had a moderate impact on the responses. The answers were mostly influenced by specialist status. CONCLUSION Graduation school, years in practice, and specialist status influence retention protocol, and evidence-based guidelines for fixed retention should be issued to minimize these effects. Based on the observation that bonding and maintenance of retainers are also performed by general dentists, these guidelines should be taught in dental school and not during post-graduate training.

Sport as a means of immigrant youth integration: An empirical study of sports, intercultural relations, and immigrant youth integration in Switzerland

Der Beitrag geht der Bedeutung des Sports für die Integration von jugendlichen Einwanderern in die Aufnahmegesellschaft nach. Aufgrund von Daten einer Querschnittstudie bei 454 Jugendlichen der ersten Einwanderergeneration aus Gymnasien, Berufsschulen und Vorlehreeinrichtungen der deutschen Schweiz zeigen unsere Ergebnisse, dass der Sport für die meisten Jugendlichen mit Migrationshintergrund ein wichtiger Teil ihrer Freizeit darstellt, auch wenn der Anteil von Migrantinnen, die Mitglied eines Sportvereins sind, im Vergleich zu Migranten zweimal niedriger ausfällt. Zudem haben sowohl männliche wie weibliche Jugendliche mit Migrationshintergrund, die Sport in einem Sportverein ausüben, deutlich mehr persönliche Kontakte mit Schweizer Peers während ihrer sportlichen Aktivitäten. Jugendliche, die von häufigen persönlichen Kontakt mit Schweizer Peers im Sport berichten, haben auch deutlich mehr interkulturelle Kontakte in ihrer Freizeit generell und innerhalb des Kreises ihren engsten Freunde. Schließlich vermögen häufige Kontakte mit Schweizer Peers im Sport das Gefühl der jugendlichen Einwanderer, in der Schweiz integriert zu sein, zu erhöhen.

Courses in the language and culture of origin and their impact on youth development in cultural transition: A study among immigrant and dual heritage youth in Switzerland

Elena Makarova traces how the concept of intercultural education in German-speaking European countries promotes the inclusion of courses in the Language and Culture of Origin (LCO) for immigrant youth in the school curriculum of host countries. Such courses are assumed to have positive effects on the development of immigrant youth in the host country. Particularly, it has been suggested that participation in LCO courses increases the self-esteem of immigrant youth, facilitates the development of their bicultural identity and improves their integration in the host society. However, there is a lack of empirical evidence on the nature of the effects of LCO course attendance on the acculturation of immigrant youth and their cultural identity. Accordingly, the aim of the study detailed in the chapter is to examine the impact of immigrant youth’s attitudes towards LCO courses and of their attendance of such courses on their acculturation and cultural identity.

The VEINES-QOL/Sym questionnaire is a reliable and valid disease-specific quality of life measure for deep vein thrombosis in elderly patients.

PURPOSE To prospectively evaluate the psychometric properties of the Venous Insufficiency Epidemiological and Economic Study (VEINES-QOL/Sym) questionnaire, an instrument to measure disease-specific quality of life and symptoms in elderly patients with deep vein thrombosis (DVT), and to validate a German version of the questionnaire. METHODS In a prospective multicenter cohort study of patients aged ≥ 65 years with acute venous thromboembolism, we used standard psychometric tests and criteria to evaluate the reliability, validity, and responsiveness of the VEINES-QOL/Sym in patients with acute symptomatic DVT. We also performed an exploratory factor analysis. RESULTS Overall, 352 French- and German-speaking patients were enrolled (response rate of 87 %). Both language versions of the VEINES-QOL/Sym showed good acceptability (missing data, floor and ceiling effects), reliability (internal consistency, item-total and inter-item correlations), validity (convergent, discriminant, known-groups differences), and responsiveness to clinical change over time in elderly patients with DVT. The exploratory factor analysis of the VEINES-QOL/Sym suggested three underlying dimensions: limitations in daily activities, DVT-related symptoms, and psychological impact. CONCLUSIONS The VEINES-QOL/Sym questionnaire is a practical, reliable, valid, and responsive instrument to measure quality of life and symptoms in elderly patients with DVT and can be used with confidence in prospective studies to measure outcomes in such patients.

Regional differences of physical activity and sedentary behaviour in Swiss children are not explained by socio-demographics or the built environment

Objective We evaluated whether regional differences in physical activity (PA) and sedentary behaviour (SB) existed along language boundaries within Switzerland and whether potential differences would be explained by socio-demographics or environmental characteristics. Methods We combined data of 611 children aged 4 to 7 years from four regional studies. PA and SB were assessed by accelerometers. Information about the socio-demographic background was obtained by questionnaires. Objective neighbourhood attributes could be linked to home addresses. Multivariate regression models were used to test associations between PA and SB and socio-demographic characteristics and neighbourhood attributes. Results Children from the German compared to the French-speaking region were more physically active and less sedentary (by 10–15 %, p < 0.01). Although German-speaking children lived in a more favourable environment and a higher socioeconomic neighbourhood (differences p < 0.001), these characteristics did not explain the differences in PA behaviour between French and German speaking. Conclusions Factors related to the language region, which might be culturally rooted were among the strongest correlates of PA and SB among Swiss children, independent of individual, social and environmental factors.

Intentionality in Reference and Action

This essay asks whether there is a relation between action-serving and meaning-serving intentions. The idea that the intentions involved in meaning and action are nominally designated alike as intentionalities does not guarantee any special logical or conceptual connections between the intentionality of referential thoughts and thought-expressive speech acts with the intentionality of doing. The latter category is typified by overt physical actions in order to communicate by engaging in speech acts, but also includes at the origin of all artistic and symbolic expression such cerebral and linguistic doings as thinking propositional thoughts. There are exactly four possibilities by which meaning and action intentionalities might be related to be systematically investigated. Meaning-serving and action-serving intentionalities, topologically speaking, might exclude one another, partially overlap with one another, or subsume one in the other or the other in the one. The theoretical separation of the two ostensible categories of intendings is criticized, as is their partial overlap, in light of the proposal that thinking and artistic and symbolic expression are activities that favor the inclusion of paradigm meaning-serving intentions as among a larger domain of action-serving intentions. The only remaining alternative is then developed, of including action-serving intentions reductively in meaning-serving intentions, and is defended as offering in an unexpected way the most cogent universal reductive ontology in which the intentionality of doing generally relates to the specific intentionality of referring in thought to the objects of predications, and of its artistic and symbolic expression.

About DNA databasing and investigative genetic analysis of externally visible characteristics: A public survey.

During the last decade, DNA profiling and the use of DNA databases have become two of the most employed instruments of police investigations. This very rapid establishment of forensic genetics is yet far from being complete. In the last few years novel types of analyses have been presented to describe phenotypically a possible perpetrator. We conducted the present study among German speaking Swiss residents for two main reasons: firstly, we aimed at getting an impression of the public awareness and acceptance of the Swiss DNA database and the perception of a hypothetical DNA database containing all Swiss residents. Secondly, we wanted to get a broader picture of how people that are not working in the field of forensic genetics think about legal permission to establish phenotypic descriptions of alleged criminals by genetic means. Even though a significant number of study participants did not even know about the existence of the Swiss DNA database, its acceptance appears to be very high. Generally our results suggest that the current forensic use of DNA profiling is considered highly trustworthy. However, the acceptance of a hypothetical universal database would be only as low as about 30% among the 284 respondents to our study, mostly because people are concerned about the security of their genetic data, their privacy or a possible risk of abuse of such a database. Concerning the genetic analysis of externally visible characteristics and biogeographical ancestry, we discover a high degree of acceptance. The acceptance decreases slightly when precise characteristics are presented to the participants in detail. About half of the respondents would be in favor of the moderate use of physical traits analyses only for serious crimes threatening life, health or sexual integrity. The possible risk of discrimination and reinforcement of racism, as discussed by scholars from anthropology, bioethics, law, philosophy and sociology, is mentioned less frequently by the study participants than we would have expected. A national DNA database and the widespread use of DNA analyses for police and justice have an impact on the entire society. Therefore the concerns of lay persons from the respective population should be heard and considered. The aims of this study were to draw a broader picture of the public opinion on DNA databasing and to contribute to the debate about the possible future use of genetics to reveal phenotypic characteristics. Our data might provide an additional perspective for experts involved in regulatory or legislative processes.